统筹方法在特需病房临床护理工作中的应用

护理工作繁琐，存在较多不确定性，临时变动较大，特需病房病人身份特殊、要求高，需要护士服务意识强，能主动为病人提供服务。特需病房多为家庭模式，一个护理单元需管理2～3层的病房，如不能合理安排工作时间，就不能完成工作任务。对处理突发性的工作时，就不能够尽善尽美地协调安排，从而影响工作的完成，降低工作效率。统筹方法是著名数学家华罗庚进行系统论述的一种安排工作进程的数学方法，其基本原理是通过网络图的形式对整个系统全面规划，并按先后顺序、轻重缓急进行协调，有效利用，达到以最少的时间和资源消耗来完成整个系统的预定计划目标。2005年2月-2007年9月我科临床工作中应用统筹方法安排工作，取得了满意的效果。     

手术室监视、监听系统的设计与应用

根据手术室的工作环境和特点，我院自行设计安装了手术室监视、监听、对讲和录像系统。作者详细介绍了系统的组成、功能特点及应用。     

Alcohol skin preparation causes surgical fires

INTRODUCTION

Surgical fires are a rare but serious preventable safety risk in modern hospitals. Data from the US show that up to 650 surgical fires occur each year, with up to 5% causing death or serious harm. This study used the National Reporting and Learning Service (NRLS) database at the National Patient Safety Agency to explore whether spirit-based surgical skin preparation fluid contributes to the cause of surgical fires.

METHODS

The NRLS database was interrogated for all incidents of surgical fires reported between 1 March 2004 and 1 March 2011. Each report was scrutinised manually to discover the cause of the fire.

RESULTS

Thirteen surgical fires were reported during the study period. Of these, 11 were found to be directly related to spirit-based surgical skin preparation or preparation soaked swabs and drapes.

CONCLUSIONS

Despite manufacturer''s instructions and warnings, surgical fires continue to occur. Guidance published in the UK and US states that spirit-based skin preparation solutions should continue to be used but sets out some precautions. It may be that fire risk should be included in pre-surgical World Health Organization checklists or in the surgical training curriculum. Surgical staff should be aware of the risk that spirit-based skin preparation fluids pose and should take action to minimise the chance of fire occurring.     

护理人员专科培训对感染重症负压病房患者临床效果探讨

目的探讨感染重症负压病房护理人员专科培训的综合效果。方法选取2013年1月~9月在感染重症负压病房住院的患者及护理人员作为研究对象,观察专科培训前后4个月的院内感染发生率、并发症发生率、患者配合度、住院时间及住院费用,并进行比较。结果专科培训后两组并发症发生率、院内感染率低于对照组,有显著性差异(P0.05),住院时间明显缩短(P0.05);配合度明显增加(P0.05)。结论对感染重症负压病房护理人员进行专科培训,可以减少患者的住院时间、院内感染率,提高患者满意度,保证患者的治疗效果,具有深远的意义。     

ClO2对手术室空气消毒效果的试验观察

目的观察二氧化氯 (ClO2 )对手术室空气的消毒效果。方法在室温 (2 0～ 2 5 )℃ ,相对湿度 5 5 %的1 0 0m3 试验手术间中 ,用浓度为 2 5 0 0mg/LClO2 强力杀菌消毒剂按 5ml/m3 进行喷雾消毒 ,分别在喷雾后 5min、1 5min、30min取样 ,同时设空白对照和蒸馏水对照 ,取样后培养 72h ,分别计数细菌菌落数。结果用ClO2 消毒后 5min、1 5min、30min的手术间中的空气细菌杀灭率分别为 6 9.0 7%、84 .5 1 %、92 .39% ,与蒸馏水对照组比较差异非常显著 (P <0 .0 1 )。结论ClO2 对空气具有较好的消毒效果 ,适用于临床手术室空气消毒     

Formaldehvde and Dhenol exposure during an anatom; dissecdon course: a Dossible source of IgE-mediated sensitizkion?

The sensitizing potency of formaldehyde and phenol exposure during 4 weeks of an anatomy dissection course was assessed in 45 medical students. Specific IgE against formaldehyde by RAST and by ELISA and specific IgE against phenol by ELISA were assessed before and after the course. At the start of the course. symptoms, type I allergy, respiratory diseases, and smoking habits were noted. At the end of the course, only symptoms experienced during the dissection lessons were assessed. Indoor formaldehyde levels were measured continuously. The mean indoor formaldehyde level was 0.124±0.05 ppm, with a minimum of 0.059 ppm and a maximum of 0.219 ppm. Specific IgE against formaldehyde or phenol was found in none of the subjects at the beginning of the course, and no student showed specific IgE against formaldehyde or phenol after the course. Assessment of primarily irritant symptoms during the lessons revealed itch and paraesthesia of hands in 33/45 students (P<0.00005), headache in 15/45 students, burning eyes in 13/45 students (P<0.02), dizziness in 8/45 students (P<0.008), sneezing in 4/45 students, epistaxis in 2/45 students, and shortness of breath in 1/45 students. According to our data, l-month exposure to formaldehyde and phenol during an anatomy dissection course does not induce specific IgE against formaldehyde or phenol.     

洁净层流手术室污染源调查分析

目的：了解层流手术室的污染来源，采取有效监控措施。方法：按医院内感染一监控与管理中规定的方法，对污染源的同一部位分手术后、常规消毒后及强化消毒措施后进行微物生学监测。结果：手术后的床垫、体位垫子、踏脚凳、拖布污染较严重，手术间回风口过滤网及手术室推车、洗器械水池均有不同程度污染。常规消毒后杀菌率分别在43％－66％左右，而强化消毒措施后杀菌率分别为83％－93％左右。结论：不能过分依赖层流手术室的空气净化系统，对于污染源手术后应立即用1：200“84”消毒液擦拭，再用紫外线距离被消毒物品30厘米左右照射30分钟，效果最好。     

What surgeons want in operating rooms

The wishes of surgeons for their operating rooms (ORs) are similar in principle to those of other workers for their work place – to be able to do their work accurately, productively, safely, and with satisfaction. To determine these wishes 40 Australian surgeons were asked what changes they would like in their operating rooms. From their responses there were 349 separate comments defined. Each comment was labeled with a keyword which was used to sort them into categories using a spreadsheet. Within each category labels were modified as appropriate and sorting was repeated several times until the groupings appeared stable. Feedback was sought from participants after circulating the collated results by email. Not surprisingly, there were problems in many areas – equipment, lighting and OR planning. Altogether there were 36 different categories of comment, with half of them having six or fewer respondents. The analysis clarified the problems of surgeons, and yielded some that were not expected. The results provide a useful tool for informing equipment designers and administrators of necessary changes. Further research with a larger number of subjects, and perhaps a prompt list, may yield additional significant information.     

一站式杂交手术室腹主动脉瘤腔内修复术的手术配合

目的 探讨一站式杂交手术室腹主动脉瘤腔内修复术的护理配合及管理.方法 总结对41例腹主动脉瘤腔内修复术配合的护理经验.结果 利用一站式杂交手术室的优势,配备素质良好的专业护理人员,做好术前、术中、术后的各项护理操作及管理,更好地配合腹主动脉瘤腔内修复术,手术护理效果理想.结论 人力资源的合理配置、科学的护理管理、精细的手术配合是杂交手术成功的关键.     

Gatekeeping practices of nurses in operating rooms

This paper explores the gatekeeping practices used by operating room nurses to control information flow in their everyday clinical practice. In nursing, gatekeeping appears only sporadically in the literature and usually emerges as a secondary concept rather than being the primary focus of studies. As gatekeeping is a communication practice that has the potential to impact directly on patient safety, a more in-depth exploration of its pervasiveness and effect needs to be undertaken. Accordingly, in this paper we aim to provide an in-depth understanding about gatekeeping practices in operating room nursing by drawing on a ‘network’ model of gatekeeping to highlight the power relationships between stakeholders and how information is controlled. To illustrate our points, we provide four different examples of gatekeeping at an interpersonal level of interaction. Data are drawn from an ethnographic study in Australia that explored nurse–nurse and nurse–doctor communication at three different operating room departments. We explore the impact of gatekeeping on social and professional relationships as well as how it has practical and ethical ramifications for patient care and the organisation of clinical work. The findings show that nurses are selective in their use of gatekeeping, depending on the perceived impact on patient care and the benefit that is accrued to nurses themselves.